By Asanti M
We will all be sick, but we will not all receive care. Our mortality guarantees the former, but it is the system, chosen for us, that forces us to cope with the latter. For the unempathetic or short-sighted among us, the latter is a sad fact, but one not worthy of any recourse. They see themselves as happily positioned to receive their care and don’t dare dream that they will ever count themselves among the sick. To them, there exists a stark separation between those who will and who won’t receive healthcare: the deserving and the listless, the good and the wicked, so on and so forth. Whatever rationale is necessary to obfuscate the human condition of ailment is employed to justify a perverse system.
The collective effort to care for the sick stands as a testament to the inherent communal nature of human life in which two important points ought to be discerned. First, there’s recognition of the necessity of communal bonds. To organize and use resources on the impaired as opposed to the healthy suggests either a strong utility to gain from the health of others, or an emotional bend towards the preservation of another that surpasses the expense necessary to care for them. Of course, both can be true at once. Second, ailment is a universality embedded in the human condition in which we all can empathetically enter, to some degree. Therefore, some semblance of systematic healthcare that promotes communal health and safeguards the fragility of life naturally emerges as a joint effort to alleviate one’s own suffering. Healthcare, being an extension of communal relations and common sentiments, is then naturally positioned as a public good.
The contortion of healthcare into a product sold solely to maximize monetary ends, fundamentally alters how we discuss and analyze the preservation of life. This peculiar transmutation yields the very sinister consequence in which callous indifference is amplified and allowed to tear apart the very basic ties of empathy. This virulent apathy numbs the public to the condemnation of our neighbors who are left to the selfish and subversive schemes of profiteers, whose existence is made entirely on maximizing public extraction. The conversation shifts from life and death, suffering and repose, to the economic jargon that surrounds the client-supplier model and wholly conceals the humanitarian gravity of such a callous approach. These profiteers move to restrict the communal aspect of healthcare fully ceding any semblance of its humanitarian nature until the sick and suffering become unwitting consumers. All talk of preservation of life loses meaning when the preservation of dividends supersedes its importance and constricts its application.
The apathy elicited by the transformation of healthcare exists not solely as a natural byproduct of the commodification, but as a sought-after condition that must be met in order to maximize the profitability of suffering. Under the benign contentment of apathy, an all too familiar structure takes root. Executives are selected to manage funds and generate profits; administrators are hired to push efficiencies towards cost reduction; and managers enter as mediators between bureaucratic will and clinical expertise. With such a normative system in place it’s difficult to see the intrinsic contradictions that produce its disparities until we look among its victims. Far too many of us are forced to weigh the options of an agonizing abstinence, or seek care that thrust us into destitution. The hailed “market forces” drive the public to the upper limit of what they can afford at which point the invisible hand of the market becomes indistinguishable from the sordid hand of death. Both equally unfeeling and equally cold. The atmosphere of apathy transitions to a confused helplessness as the general public questions “how did we get here” and any answer provided sums up to “this is how things have to be”.
With the inquisition underway, the public forcefully ascribes their poor conditions to a variety of pernicious players, accusing them of all manner of “rule breaking” leading to the degradation of the system. This line of thought mistakenly grants too much consequence and culpability to the disposition of individual players and fails to see the ghost in the machine, the invisible hand. To perform well in an environment bent on making profit is to shift efforts towards that end as demanded by competition or collusion, despite how scrupulous an individual might be. What results is a race yielding higher and higher costs of care, even if it means neglecting the preservation of life. This is not to say that any one profiteer acts as an exceptionally malevolent operator but acknowledges that their motives are entirely irrelevant when positioned within a system designed to commodify life and wellness. Competition rewarded based on the generation of revenue bends the health care industry towards extraction. Hospitals, insurance agencies, pharmaceuticals, medical device companies, medical coders, etc. all claw to extract as much wealth from the public as possible. This economic position is by no means unique, but when adopted by health care it’s difficult to distinguish lifesaving medical treatment from extortion. The makeup of such a system leaves culpability lost in its machinery. Employers move to stay alive in response to market forces and employees follow suit so as to not become victims themselves. Cornered clinicians are reduced to cogs, and whether ambivalent or begrudging, complicity becomes the defining mode of all components. Each piece turns independently towards their personal wellbeing, and in doing so inadvertently line the gears perfectly to perpetuate our Machiavellian healthcare machine.
The life of our Frankenstein system requires close collusion between those who benefit from its monstrous design, and the absolute atomization of all who blindly grasp its contours with their hopes and fears in hand. Collective action is reserved for the corporate but fiercely condemned amongst the “consumers” and the “cogs”. Collusion at every junction of our system forces both prices and public confusion to outpace legislation as monopolies systematically tip the scale in their favor. It’s imperative that “consumers” remain impotent and assert no will that runs contrary towards the higher purpose of profit if healthcare is to exist solely as a commodity. The ideal consumer becomes both the perpetrator and the victim. Under the cloak of apathy, the national exaltation of the individual over the community begets an ecosystem ideal to undermine any step towards humanitarian solidarity. However, in true dialectical fashion, the conditions forced on the majority become a unifying factor, fomenting the prerequisites for change and tearing at the seams of apathy. The countless barriers to access once again make the inescapable nature of ailment front and center in the national consciousness. Through the lens of solidarity any system that forces such a cruel reality on far too many of us becomes criminal; the callous discussions surrounding human life become untenable; and the humanitarian position becomes emboldened. The unified potential of the uncared-for drives discussions both foreboding and inspiring as an opportunity to steer history emerges.
Further Reading
- An American Sickness by Elisabeth Rosenthal
- Priced Out by Uwe E. Reinhardt
- The Tyranny of Merit: Can We Find the Common Good by Michael J. Sandel
- Evicted by Matthew Desmon